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Biliary reconstruction in liver transplant patients with primary sclerosing cholangitis, duct‐to‐duct or Roux‐en‐Y?
Author(s) -
Shamsaeefar Alireza,
Shafiee Mohammad,
Nikeghbalian Saman,
Kazemi Kourosh,
Mansorian Mohsenreza,
Motazedian Nasrin,
Afshinnia Farsad,
Geramizadeh Bita,
Malekhosseini Seyed Ali
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12964
Subject(s) - medicine , primary sclerosing cholangitis , liver transplantation , roux en y anastomosis , anastomosis , complication , bile duct , surgery , gastroenterology , biliary tract , transplantation , disease , weight loss , gastric bypass , obesity
Roux‐en‐Y choledochojejunostomy and duct‐to‐duct (D‐D) anastomosis are biliary reconstruction methods for liver transplantation. However, there is a controversy over which method produces better results. We have compared the outcome of D‐D anastomosis vs. Roux‐en‐Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in Shiraz Organ Transplant Center. Materials The medical records of 405 patients with primary sclerosing cholangitis ( PSC ) who had undergone liver transplant from 1996 to 2015 were reviewed. Patients were divided into two groups: Roux‐en‐Y group and D‐D group. Morbidity, disease recurrence, and graft and patient survival rates were compared between the two groups. Results Total of 143 patients underwent a D‐D biliary reconstruction, and 260 patients had a Roux‐en‐Y loop. Biliary complication involved 4.2% of patients from the D‐D group, and 3.9% from the Roux‐en‐Y group ( P =. 863). Actuarial 1‐, 3‐, and 5‐year patient survival for D‐D and Roux‐en‐Y group was 92%, 85%, and 74%; and 87%, 83%, and 79%, respectively ( P =.384). The corresponding 1‐, 3‐, and 5‐year probability of biliary complication was 97%, 95%, and 92%; and 98%, 97%, and 94%, respectively ( P =.61). Conclusion Duct‐to‐duct biliary reconstruction in liver transplantation for selected patients with PSC is a good alternative instead of Roux‐en‐Y biliary reconstruction.